Grand Rounds

Does a Hysterectomy before 50 Shorten Lifespan?

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BACKGROUND AND PURPOSE:

  • Wilson et al. (AJOG, 2018) sought to determine whether receiving a hysterectomy, with or without oophorectomy, before the age of 50 had a higher all-cause mortality

METHODS:

  • Study sample derived from a prospective cohort study
    • Designed to assess physical and mental health
  • Women reported either
    • Hysterectomy with bilateral oophorectomy
    • A hysterectomy without bilateral oophorectomy (retained one or both ovaries)
    • No hysterectomy
  • Exposure groups were stratified by menopausal hormone therapy use
  • Covariates also analyzed included
    • Demographics/income | Health behaviors such as smoking and alcohol consumption | Medical history such as diabetes and/or obesity

RESULTS:

  • 13,541 women were included in the study
    • Median follow-up of 21.5 years
  • Overall, there was no difference in all-cause mortality compared to women with no hysterectomy
    • Women who reported a hysterectomy and bilateral oophorectomy
      • Hazard ratio (HR) 1.02 (95% confidence interval, 0.78–1.34)
    • Women who reported a hysterectomy with ovarian conservation
      • HR 0.86 (95% confidence interval, 0.72–1.02)
    • When stratified by hormone therapy
      • Hysterectomy and ovarian conservation <50 years were not at higher risk of all-cause mortality compared to no hysterectomy, regardless of hormone therapy
      • In nonusers of hormone therapy, hysterectomy-with bilateral oophorectomy <50 years was associated with increased mortality vs no hysterectomy
        • HR 1.81 (95% confidence interval, 1.01–3.25)

CONCLUSION:

  • Hysterectomy and ovarian conservation <50 did not increase risk of all-cause mortality
  • Hysterectomy without ovarian conservation and no hormone therapy did increase risk of all-cause mortality

Learn More – Primary Sources:

Hysterectomy status and all-cause mortality in a 21-year Australian population-based cohort study

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Related ObG Topics:

‘Opportunistic’ Salpingectomy at the Time of Hysterectomy: Risks vs Benefits
The WHI Randomized Trials: Is Menopausal Hormone Therapy Associated with Long-Term Mortality?
Does Hormone Therapy in Menopause Impact Mortality?

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